How deinstitutionalization moved thousands of mentally ill people out of hospitals—and into jails and prisons.

The rebuilt Public Hospital for Persons of Insane and Disordered Minds in Williamsburg. Wikipedia

1841

Boston schoolteacher Dorothea Dix visits the East Cambridge Jail, where she first sees the horrible living conditions of the mentally ill. Believing they could be cured, Dix lobbies lawmakers and courts for better treatment until her death in 1887. Her efforts lead to the establishment of 110 psychiatric hospitals by 1880.

Dorothea Dix Wikipedia

1887

On assignment for New York World, Nellie Bly feigns lunacy in order to be admitted to the Women's Lunatic Asylum on New York’s Blackwell's Island. Her exposé, "Ten Days in a Mad-house,” detailing the appalling living conditions at the asylum, leads to a grand jury investigation and needed reforms at the institution.

Dr. Walter Freeman and his colleague James Watt perform the first prefrontal lobotomy. By the late 1950s, an estimated 50,000 lobotomies are performed in the United States.

Dr. Walter Freeman and Dr. James Watts examine an X-ray before a psychosurgical procedure. Wikipedia

1938

Italian neurologist Ugo Cerletti introduces electroshock therapy as a treatment for people with schizophrenia and other chronic mental illnesses.

A man sits in a Bergonic chair for electroshock treatment. Wikipedia

1946

President Harry Truman signs the National Mental Health Act, calling for the establishment of the National Institute of Mental Health to conduct research into neuropsychiatric problems.

1954

Marketed as Thorazine by Smith-Kline and French, chlorpromazine is the first antipsychotic drug approved by the Food and Drug Administration. It quickly becomes a staple in asylums.

A 1962 advertisement for Thorazine. Wikipedia

1955

The number of mentally ill people in public psychiatric hospitals peaks at 560,000.

1962

One Flew Over the Cuckoo's Nest, a novel by Ken Kesey, is published. The bestseller is based on his experience working the as a nurse's aide in the psychiatric wing of Menlo Park Veteran's Hospital in California.

Wikipedia

1963

President John F. Kennedy signs the Community Mental Health Act to provide federal funding for the construction of community-based preventive care and treatment facilities. Between the Vietnam War and an economic crisis, the program was never adequately funded.

1965

With the passage of Medicaid, states are incentivized to move patients out of state mental hospitals and into nursing homes and general hospitals because the program excludes coverage for people in "institutions for mental diseases."

Dmitry Kalinovsky/Shutterstock

1967

The California Legislature passes the Lanterman-Petris-Short Act, which makes involuntary hospitalization of mentally ill people vastly more difficult. One year after the law goes into effect, the number of mentally ill people in the criminal-justice system doubles.

President Jimmy Carter signs the Mental Health Systems Act, which aims to restructure the community mental-health-center program and improve services for people with chronic mental illness.

President Jimmy Carter Library of Congress

1981

Under President Ronald Reagan, the Omnibus Budget Reconciliation Act repeals Carter's community health legislation and establishes block grants for the states, ending the federal government's role in providing services to the mentally ill. Federal mental-health spending decreases by 30 percent.

President Ronald Reagan Library of Congress

1984

An Ohio-based study finds that up to 30 percent of homeless people are thought to suffer from serious mental illness.

Clozapine, the first "atypical" antipsychotic drug to be developed, is approved by the FDA as a treatment for schizophrenia.

2004

Studies suggest approximately 16 percent of prison and jail inmates are seriously mentally ill, roughly 320,000 people. This year, there are about 100,000 psychiatric beds in public and private hospitals. That means there are more three times as many seriously mentally ill people in jails and prisons than in hospitals.

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2009

In the aftermath of the Great Recession, states are forced to cut $4.35 billion in public mental-health spending over the next three years, the largest reduction in funding since deinstitutionalization.

2010

There are 43,000 psychiatric beds in the United States, or about 14 beds per 100,000 people—the same ratio as in 1850.